Gracilis muscle transplant
Gracilis muscle transplant/ Gracilis Free Flap
(Months after the facial paralysis procedure, the patient continues
to see improvement in facial reanimation and symmetry.)
Image showing area of incision after patient has healed from
gracilis flap muscle transplant surgery with Dr. Azizzadeh.
In patients with long-term paralysis (> 2 years), the native facial muscles are not functional. A transplanted muscle from the groin (gracilis muscle) is necessary if one desires to create a natural and spontaneous facial movement. The gracilis muscle is located in the inner aspect of the thigh. This muscle is very special because it can be transplanted to the face with its nerve, artery and vein. A small segment can be used which can then be attached to cross-facial nerve grafts or hypoglossal nerve (see cross facial nerve grafts). Dr. Azizzadeh utilizes microsurgical techniques to perform this operation. In order to determine the candidacy of each patient for this procedure, Dr. Azizzadeh must examine the patient as well as perform pre-operative testing to ensure a successful treatment.
Why Use Gracilis Flap Transfers
The most common indication for gracilis free flap in head and neck reconstruction is for dynamic reanimation of the mid face and, occasionally, for the eye and forehead of the patient with permanent long-standing or congenital facial paralysis. In these 2 types of facial paralysis, the native facial musculature is absent because of either severe atrophy or congenital causes.
In cases of long-standing secondary facial paralysis, a branch of the contralateral normal facial nerve via a cross-facial nerve graft is used for neural input. In cases of congenital facial paralysis, an alternative nerve graft (trigeminal or hypoglossal nerve) can be used for neural input. Less common indications include reconstruction of total or near-total glossectomy defect, repair of full-thickness scalp defects due to surgery or trauma, and soft tissue filling for surgical defects (eg, orbital exenteration). (Source: Tissue Transfer, Gracilis, Author: Jason H Kim, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of California at Irvine
Illustration showing how the arteries and veins of the gracilis
muscle should be sewn correctly to the facial arteries and veins
during the second stage of facial paralysis reconstruction.
Uses of the Gracilis Flap
The Gracilis flap surgery is used for many purposes in reanimation surgery including rebuilding breast in cancer survivors. The Gracilis Free flap method, does have drawbacks for recovery of the donor site in length of time, however the results often outweigh these drawbacks.
The Gracilis flap, if warranted, is a major player in reanimating the nerves and muscles of the face. With the right surgeons and surgical teams this surgical operation can be quick and painless. However recovery time for both the donor site and the reanimation can be longer than other methods. The use of this method of reanimation is used in extreme cases where the surgical team feels other methods would not be as helpful. The Gracilis free flap uses tissue and muscle from the donor area and is most often used when an area of the face is indented because of trauma, or birth defect in the face or neck.
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MEET DR. AZIZZADEH
BABAK AZIZZADEH, MD FACS
Director, The Facial Paralysis Institute - Associate Clinical Professor - Facial Plastic & Reconstructive Surgery David Geffen School of Medicine at UCLA
FACIAL NERVE TEXTBOOK
Dr. Azizzadeh’s facial nerve textbook is the preeminent textbook for doctors on the subject.